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Improvement: Wedding Day
I discovered FlakeHQ while surfing the web about a month ago.
I have mild plaque psoriasis with the worst patches occurring on my
scalp, some nail psoriasis (thumb and big toe), and some stubborn small
patches on my torso and underneath one of my breasts.
(I was diagnosed with P about 8 years ago — when I was 20 — and
it has mostly waned except in the winter and periods of great stress). I
recently fired one derm (she cancelled too many appointments, wrote me
scrips without adequate explanation, kept me waiting two hours, etc.) and
found a new one. I should add,
as an aside, that the reason for this was that my P was flaring (a word I
just learned) at its worst ever and I am getting married in three months
and am concerned about my P on my wedding day (a vanity I am allowing
My new derm
prescribed the following: Olux Foam for the scalp, which has worked thus
far quite well. I had tried
DermaSmoothe before but really hate going to bed with an oily head covered
by a shower cap, and my job/life don't allow me to apply and leave on for
several hours unless I am asleep. I
am, however, slightly concerned about the rebound effect that might occur
when I stop using the Olux. But
I think that the two shampoos (Nizoral/T-Gel on alternate days) are
helping as well.
prescribed Dovonex applications in the morning with Ultravate at night.
As it happens my pharmacy was out of Ultravate and I had to wait
before picking up the prescription so I used Dovonex exclusively for about
four days, and noted huge improvement on my smallest lesions, some
improvement on the others. I
noted, by the way (because I had recently read your Dovonex trial) that in
the prescribing info it recommends Dovonex only for mild to moderate P.
I wonder if that is because the larger the lesion, the less
effective it is?
When I used the
Ultravate for the first time I noticed that my skin had bleached the
following morning at the area where I had used it.
Do you have any idea why that might be?
It concerns me for obvious reasons (keep in mind that I am not dark
skinned at all, rather am of Eastern European Jewish descent so am as pale
as they come and my skin still looked even paler).
prescribed Elidel (a non-steroidal cream) for the region under my breast.
This seems to be working, but I need some more time to know for
sure on that. I had tried
Dovonex under the breast years and years ago (when Dovonex was first
released) but it made the skin crack and bleed (not a fun situation when
wearing a bra). I realize that
you are not female, but perhaps you could point me in the direction of how
other women have dealt with this problem?
rambling at length, it is simply that yours is the first site I have found
that has answered any questions I have had (other than NPF’s site[ ])
and I know no psoriatics to interrogate.
Thanks for all you do. –Rachel
congratulations on your upcoming wedding, Rachel.
Nobody wants to be flaming upon that occasion, so I hope by then
your crisis will have passed..
about Dovonex perhaps not working as well on larger lesions is a good one.
You’re right about the fact that when I tried Dovonex and wrote
about it I was worse than moderate, and Dovonex is recommended for mild to moderate P.
I’d never thought about lesion size, but in some respects it
makes sense that any topical medication is likely to have a harder time
working on larger lesions. Larger
lesions — on me at least — tend to be thicker lesions, too.
A lesion is “thick” for two reasons: one, inflammation swells
certain layers of the dermis; and two, the top layers of skin die off many
times faster than normal forming the flakes or crusts that are typical of
plaque P. These flakes and
crusts can’t benefit from the topical medication, so the medication must
penetrate through them to get to
the living tissue that can be helped.
This penetration business is a time-limited phenomenon, as it
pretty much must occur before the base (the oil, cream, or ointment
carrying the medicine) evaporates or gets rubbed off.
This means less of it is going to get through the thick flakes or
crust of a large lesion.
hearing nothing but good things about the Dovonex/Ultravate combo therapy.
I’m going to be starting it myself day after tomorrow.
My derm instructed me to mix equal parts of the two in the palm of
my hand and apply them together. I’m
wondering if this is effectively any different than the
one-in-the-morning, other-at-night regimen your derm prescribed?
I will be very
happy if my lesions, too, have waned by the time you get married!
With regard to
OTC shampoos. I never had much
luck with Nizoral and, before methotrexate finally calmed my scalp P, I
considered T-Gel second best to Pentrax.
Pentrax, which I believe is manufactured in Canada, was difficult
for me to keep stocked; so, more often than not, I had to make do with the
T-Gel. Some years into my
worst scalp P, Neutrogena came out with T-Gel Extra Strength.
Still not as potent as Pentrax (less percentage of coal tar
derivative), it did much better than the original T-Gel.
It worked so well, in fact, that I stopped fuming about my
inability to find Pentrax. Today
I use regular T-Gel as my daily shampoo.
(This is probably overkill, but I’m used to it and I don’t EVER
want to see my scalp P again.) If
an errant itch happens, or there is any other slightest suggestion that a
lesion might be re-activating up there, I switch to T-Gel Extra Strength
for a few days. So far, knock
on wood, the scalp P has remained at bay.
Has your derm
ever suggested the P under your breasts may be “flexural” P?
This is also called inverse
psoriasis. It tends to
look like patches of red, inflamed skin, but without the prominent
thickening or scale build-up. My
flexural P (groin area) itches the worst and causes the most pain (I guess
Jockey shorts are about as friendly to flexural P as brassieres are to
whatever kind it is you have under your breasts).
I use a very mild corticosteroid cream — Westcort — on my
flexural and, usually, after a few days of application, it abates.
Good luck and stay in touch. We won’t expect to hear from you until after the honeymoon — which I’m confident won’t be hampered in the slightest by your P. -Ed